| NPI | 1215727722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA BUZBEE Office Manager 254-968-9936 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine |
| 261QH0100X Clinic/Center Health Service | |
| 261QS1000X Clinic/Center Student Health | |
| Enumeration Date | 2025-05-08 |
| Last Update Date | 2025-05-20 |